Monday, July 21, 2008

...and my six-month A1C is (drum roll please): 6.1. Looks I'm out of the 5% club for now...}:-( But at least everything else is in check, except my pesky HDL numbers (still abysmally low at 26). The BP front looks better too...might just be a case of white-coat syndrome. Or L-I-F-E...! Thanks for your input on how to handle my doctor, OC friends. I think I'll bring it up next time, as gently as possible. We'll see how it goes in 3 months' time {:-)I'm sending out a shout to Kerri today--hope this sends a smile and a little cheer your way!

Friday, July 18, 2008

I'm waiting for my A1C results today, after a whirlwind of six-month-follow-up appointments yesterday. (I also gave blood for a research study for the first time, which was exciting.) Though I'm pretty confident my level will be around the same as it was in January, I come to you conflicted, O Blogosphere, for I have lost confidence in someone very important: my primary care physician. What to do? Here's a little context:The Good:

She's been my PCP since 1995

She was the one to urge me to switch to Lantus back in 2000

She's helped me get my A1Cs down from the high 7s to the mid- to high 5s

She's on staff at a major teaching hospital, which has long specialized in diabetes care

The Not-So-Good:

At my last three appointments (in the last 9 months or so) the office seemed more frantic and less organized than usual (forgetting my appointment, losing my chart, etc.)

At my last appointment (yesterday), she actually told me to "back off" my intensive management and cited the ACCORD study as evidence that "a lower A1C increases your risk of a heart attack." (and yes, D-world, I was shocked...I remember reading this thread among others, along with the ACCORD and ADVANCE studies, and coming to the conclusion that as a type 1, neither applied to me. I thought the American Association of Clinical Endocrinologists' guidelines were pretty clear on this too...)

She hasn't reviewed any of my medications in a year

I was the one to remind her of what tests needed to be done--yesterday I wouldn't have had a urinalysis or a foot inspection if I hadn't prompted her

There's something missing I can't put my finger on...lack of attention, maybe? Also at my last three appointments, she has seemed noticeably more distracted and less familiar with me & my history.

I'm befuddled, dear OC friends. As alarming as it is to hear a doctor tell me to let my A1Cs go up, contrary to all the evidence, she also wants me to see her in a month to follow up on some wonky blood pressure numbers. (Yes, I may need another pill...ugh.) So I can't fault her for lack of care there.

My husband recommends I think about it, then write her a letter or mention my concerns to her at that follow-up appoinment. In unrelated matters it is far more difficult for me to physically get to her office nowadays. I might be better off with a doctor in my own neck of the woods, or closer to my excellent eye and girl doctors. What do you think, dear OC? Should I bring it up, or just cut her a break and let it go?

Friday, July 11, 2008

Hope the rest of the OC has been faring well so far this summer. In the past month, my place of employment has a) reincorporated, b) moved to a new office, c) changed all its providers (though not health insurance...yet), and d) lost its computer network. Twice. Oh, and my commute doubled from 45 minutes to 90, and a workplace Surf Nazi has made it difficult for me to do anything online including blogging. Ugh.

But more on that later. Tonight I'm thinking about my grandmother, who would have been a whopping 94 years old this July. She's been gone 10 years now, but the heartache of life without her lingers. When I was little going to Gram's house was a magical time, filled with special foods only she gave us: orange sherbet, butter mints, graham crackers with butter and honey and, on special occasions, freezer cakes or fudge sundaes from the ice cream parlor down the street.

Diabetes changed all that, of course. She didn't understand it; when I left the hospital after being diagnosed she told me, "Be good and do what the doctors tell you, and you'll get better." Later she must have realized how much things had changed. But Gram always made me feel included, no matter what. The dinner table always had canned peaches or fruit cocktail for me (back in the days of "heavy syrup", she would carefully rinse everything and serve it in a crystal bowl. "Because you're special," she would say, and pat my shoulder.). I might not have been able to eat Oreos for dessert with my brother anymore, but she made sure I always had plain vanilla wafers and a banana. God love her, she often ruined perfectly good strawberries by dousing them in saccharin...but I smiled and thanked her and ate every last one. Every time.

We used to go shopping, Gram and I, when I first learned how to drive. I always got a kick out of looking at clothes together or talking about family things. She would crack me up by eating at McDonald's with me in the mall, with her high heels and perfectly done hair and makeup and designer clothes. ("They're the only ones who have fresh coffee," she would say. Hot black coffee was her drink of choice, be it 32 or 92 degrees outside.) She never asked me if I was low or high, because back then there was no way to tell. But when I got my own apartment she would tell my parents, "Don't worry, she'll be okay. She knows how to take care of herself."

We laid her to rest on a beautiful May morning. On her Mass card, we chose this verse:“May the raindrops fall lightly on your brow. May the soft winds freshen your spirit. May the sunshine brighten your heart. May the burdens of the day rest lightly upon you, And may God enfold you in the mantle of His love.”

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